How waived EHR data fees could make interoperability a 'commodity'

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Now that several major electronic health record vendors have announced they will be waiving their data sharing fees (most recently Epic), it's up to IT departments to make sure their organizations can leverage this new level of interoperability.

Several leading healthcare IT experts weighed in with Healthcare Dive as they simultaneously champion the end to a major interoperability roadblock and warn organizations that it will still take effort to facilitate the free flow of data—and that now it will be expected.

What will vendors do next?

Some vendors' data exchange fee arrangements may have limitations.

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The announcements from companies including Epic, athenahealth and Cerner all suggest positive changes. However, some vendors' arrangements may have limitations and organizations working with EHRs should fully investigate the details.

Lisa Khorey, an executive director at EY and former CIO and Director of Interoperability at the University of Pittsburgh Medical Center, says she was surprised to see that some of the announcements include end dates to the promised fee waivers.

She believes that strategically, the end dates are stated to provide the companies with recourse in case the moves appear to erode a market, but she doesn't expect that to happen and believes vendors will continue to face pressure in the public domain to keep the information freely available.

Healthcare organizations also need to look closely at the details of what their vendor is doing, because some may be looking to obtain those former fees in different ways, says Dr. Philip Marshall, MD, MPH, co-founder of Conversa Health, a digital health startup focused on improving communications between care providers and patients.

For example, instead of charging a per-transaction fee, vendors may intend to charge a per-patient monthly or annual fee. Even so, however, he calls the moves directionally correct.

New expectations for healthcare organizations

Will #interoperability become a commodity?

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As long as interoperability remains free, Khorey believes it will become more of a commodity and that pressure will mount to get connected.

"I think what will actually play out over the next couple of years is that in time, there will be continued awareness and expectation around the ability to exchange data," she says. "If a lack of connectivity continues to exist within some healthcare organizations, I think that will start to become a dissatisfier for patients, because an organization's inability to interoperate puts the burden on the patient."

Khorey notes that even with fees, anyone who has truly wanted to interoperate already could, but the removal of the cost issue changes the expectation to one that everyone not only can but should inter-operate. "Those barriers are now more organizationally related vs. related to the price point," she says.

"The power of interoperability is demonstrated in every industry outside healthcare and it can be realized within healthcare—it's more a matter now of will," Khorey said.

Responsibility now falls to IT

"It's not enough for vendors to take pricing [for interoperability] out of the equation."

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That pressure to get connected now falls on the shoulders of healthcare IT departments.

Khorey suggests IT leaders have an obligation to provide the appropriate infrastructure and connectivity strategy within their organization, to work with their vendors to ensure interoperability can be realized at their organization, and to ensure that it's ultimately easy for patients.

"It's not enough for vendors to take pricing out of the equation; it actually has to get on the IT agenda as work that is important and will be accomplished," she says.

Similar sentiments are echoed by Jitin Asnaanii, Executive Director at CommonWell Health Alliance, a consortium created in 2013 to develop a proprietary interoperability platform.

"I caution health IT professionals everywhere that just because something is 'free,' it does not mean that it actually gets used," Asnaani told Healthcare Dive. "There are two key factors that will drive real-world exchange and usage of health information: (a) availability of functioning interoperability services to the those who need them; and (b) access to the data when and where it is needed."

Asnaani suggests the necessary services should be built in to EHRs in order to make them quickly available to users and to allow providers to have access to the data natively.

"At the end of the day, patients and providers win when interoperability becomes a utility—ubiquitous, low-cost, and highly accessible—rather than the privileged 'nice to have' service that can cost an arm and a leg today," he says.

Moving forward: Standardized APIs

The IT bottleneck could be opened up by if vendors shared their API frameworks.

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Conversa Health co-founder and chief product officer Philip Marshall, MD notes the waiver news, in combination with the recent MU Stage 3 proposal, points toward progress ahead. The proposal recommends that an application programming interface be available so that a patient with login credentials can use an application of their choice to retrieve their information and use it in the ways they see fit.

"That technical mechanism and it being part of a proposed standard is a huge step forward," he says.

When a healthcare institution currently wants to implement capabilities it often needs approval from its EHR company and the vendor needs to do the work. This is an incredible barrier, Marshall says. However, that bottleneck could be opened up by the companies sharing their API frameworks. He is looking toward these becoming standardized and publicly available.

A lot of people immediately jump to risk when it comes to patient access to data, Marshall says, but he doesn't see any reason for new privacy and security concerns regarding what patients might do with their data.

"API access is the same thing as being able to download your data," Marshall said. "It's just doing it in a sophisticated and modern way."

"If [API standardization] happens, IT departments won't have to chase opportunities for consumer apps and then build something to them, because at that point they would be working from a standardized API," Marshall says.

That could leave IT departments free to focus on the specifics of making sure the data is useful and actionable to their institution; to support internal analytics to look at benchmarks, etc.; and to turn their attention to how to best leverage patient generated data.